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肥胖患者妇科腹腔镜trocar穿刺方法探讨(1)
http://www.100md.com 2011年11月25日 陈秀丽
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     [摘要] 目的 探讨妇科肥胖患者trocar穿刺成功入腹方法。方法 选择我院2009~2011年6月前入院、并予以腹腔镜手术的肥胖患者45例,随机分为A、B、C三组,各组在年龄、体重、身高等方面无明显差异。同一手术者及助手配合进行腹腔镜手术。A组予以常规脐孔上缘10mm切开,先气腹再穿刺;B组先脐孔下缘切开3mm气腹针穿刺入腹充气,再脐孔上缘切开10mm trocar穿刺入腹;C组直接于脐孔上缘切开10mm,直接trocar穿刺入腹。三组下腹麦氏点及对称处穿刺方法相同,比较三组成功率 。结果 B、A、C组成功率逐步递减,有统计学意义(P<0.05)。结论 妇科肥胖患者trocar穿刺入腹,可以先脐孔下缘穿刺入腹充气,再脐孔上缘切开10mm穿刺入腹,成功率较高,具有一定的推广利用价值。

    [关键词] 腹腔镜 ; trocar穿刺 ; 皮下气肿

    [中图分类号] R737.11 [文献标识码] B [文章编号] 1673-9701(2011)33-130-02

    Explore the Ways of Trocar for Insertion Obese Women in Gynaecological Laparoscopy

    CHEN Xiuli

    Jiangsu Province Yangzhou City Jiangdu Maternity and Child Care Centers , Yangzhou 225200 , China

    [Abstract] Objective To study the method of ahdermen puueture for gynecology obese parients. Methods Choosed from 2009 to June 2011 the hospital and be laparoscopic surgery obese patients in 45 cases as the research object, randomly divided them into A, B and C three groups, two groups in the age, weight and height, etc have no obvious difference. The same surgery and assistant with laparoscopic surgery. Group A conventional fibre-optic with holes shall be 10 mm cut, first gasless laparoscopic again puncture. Group B first hole cut 3 mm umbilical inferior needle biopsy into the abdomen gasless laparoscopic inflatable, again with umbilical hole cut 10 mm trocar puncture into the abdomen. Group C in umbilical hole directly cut margin 10 mm, trocar directly into the abdominal puncture. Three groups of abdominal McIntosh point and symmetrical place puncture of the same, compared with two power Results B, A, C power of progressive diminution had a statistical significance(P<0.05). Conclusion Gynecological obese patients trocar into the abdominal puncture, start pushing into the abdominal puncture umbilical hole inflatable, again with umbilical hole cut 10 mm puncture into the abdomen, high success rate, has some of the promotion use value .

    [Key words] Laparoscopic ;Trocar puncture ;Subcutaneous emphysema

    腹腔镜手术作为微创手术的重要组成部分,在妇科手术中的地位越来越重要,并造福了大批患者,尤其肥胖女性,避免了切口难以愈合等诸多弊端,但是肥胖患者trocar穿刺入腹也是难题,甚至最终仍转为开腹。

    1 资料与方法

    1.1 一般情况

    选择我院2009~2011年6月前入院的腹腔镜手术患者45例,年龄25~49岁,平均41.7岁。均既往体健,已生育,无手术史,无凝血机制异常,无糖尿病等内分泌疾病史。体重82~115kg,平均90.8kg,身高155~167cm,均外观肥胖,BMI均>35 ......

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